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There have been conflicting reports of the effects on seizure control of prescribing melatonin for people with epilepsy.1–4 We undertook a retrospective before-and-after observational study of 13 young people prescribed melatonin for sleep disturbances at the David Lewis Centre, a residential school for children and young adults with severe epilepsy and learning difficulties situated in Cheshire, UK, with particular focus on any changes in seizure frequency.
At the David Lewis Centre each patient has a comprehensive record of their daily seizure profiles (seizure numbers and seizure types over 24 hours) carefully documented by care workers. Daily seizure rates were tabulated for each young person at 3 months, 1 month, 1 week, and 24 hours before and after the start of melatonin administration. Data were analysed using the Wilcoxon signed ranks test.
Eleven children (aged 6–18 years, mean age 14.1) and two adults were included. All had severe learning disabilities and behavioural problems, 12 had autistic spectrum disorders, and 11 suffered from severe epilepsy. All of the young people had severe sleep disturbance.
The dose of melatonin ranged from 2–6 mg nocte with a mean dose of 4.8 mg (SD 1.54) (0.1 mg/kg/day, SD 0.05). Eleven of the 13 young people slept better with melatonin. Two discontinued melatonin due to lack of efficacy. For the remainder the mean length of time on melatonin was 2.6 years. One person showed worsening behaviour following melatonin initiation, but no other side effects were observed. Of those with epilepsy three had an increase in seizure rate, seven had a decreased seizure rate, and one patient had no observable difference. The Wilcoxon signed ranks test was applied to the data using a significance level of 0.05. The p value was insignificant (>0.05) for all four time parameters, indicating that in this study melatonin had no effect on seizure frequency.
Our experience has been that melatonin can be helpful for sleep disturbance in young people with significant neurological impairment without a demonstrable influence on seizure control.
Competing interests: none
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